UH Manoa alcohol prevention efforts appear to be paying off

Alcohol prevention efforts at the University of Hawai‘i at Mānoa (UHM) may be beginning to produce positive changes in students‘ drinking behaviors. A series of surveys conducted over the past three years show that Mānoa students tend to drink alcohol less than their peers at other universities, and also show some decline in numbers of Mānoa students who drink and who "binge drink." However, prevention efforts will need to continue over the long term to create meaningful change among the minority of students who practice high risk drinking, and to alert students to the danger of driving after drinking.

Results of the surveys are reported below:

National College Health Assessment Results

The National College Health Assessment-web is an online survey developed by the American College Health Association (American College Health Association, 2007). Last spring, 2007, over 71,000 students at 107 institutions of higher education took the survey. The Health Promotion Program, under University Health Services Manoa, arranged for survey administration on the UHM campus, and results are now available. The UHM data is based on 479 respondents from a random sample of 3,400 undergraduates.A comparison between UHM and the national reference group indicates that alcohol consumption is lower at UH Manoa than for institutions of higher education on average.

Almost 43% of UHM respondents said they never drink alcohol or hadn‘t used alcohol in the past 30 days, compared to less than 33% of the reference group. About 38% of the reference group, compared to 29% of the UHM group, had five or more drinks at a sitting within the last two weeks. Five or more drinks at a sitting for men and four or more for women is considered "binge drinking", which puts one at risk for health problems and multiple immediate negative consequences.

In keeping with lower drinking rates, fewer undergraduate students at UHM experienced negative consequences from alcohol consumption than their national peer group. About 28% of UHM undergraduate students who drink, compared to 36% of the national group, did something they later regretted as a consequence of drinking; 22% at UHM, compared to 31% nationally, forgot where they were or what they did, and 12% at UHM, versus about 16% nationally, had unprotected sex as a consequence of alcohol consumption.

Close to 8% of the national group indicated that they had experienced negative academic consequences from alcohol use (received a lower exam grade, a lower course grade, or received an incomplete/dropped a course. At UHM, about 6% experienced these academic consequences.

It is reassuring to know that most UHM students either don‘t drink at all or drink moderately and safely. However, there are still students consuming alcohol illegally (under age 21), and students at risk for negative consequences, including alcohol poisoning, accidents, and unplanned or unwanted sexual encounters. Drinking and driving is a major area of concern; this is the one area in which UHM students are perhaps at higher risk than the national group. When reporting on the last school year, 40% of those UHM respondents who drank indicated they "always" used a designated driver after "partying/socializing", whereas 59% of those in the national group "always" used a designated driver. Although this difference could reflect higher rates of taking the bus or walking in Hawai'i, it is certainly an area to be investigated further. Interestingly, recent national data indicate that Hawai'i is 15th highest among the fifty states in rates of driving after drinking, for all age groups. Hopefully, recent changes in Hawai'i law, especially in regard to underage drinking and driving, will have a positive impact on these numbers.

The Manoa Alcohol Project

Beginning in June, 2005, a U.S. Department of Education grant under the Office of Safe and Drug Free Schools enabled the Health Promotion Program, working collaboratively with Student Housing, to target freshmen in UHM‘s resident halls. This endeavor (the Manoa Alcohol Project) ended in December, 2007, with the major preventive efforts occurring from fall, 2005 through spring, 2007. The overall goal was to reduce alcohol consumption among freshman residents. The project aimed to correct student misperceptions of drinking norms through posters, games, and small group education. (Students tend to think fellow students are drinking more than they actually are and thus may feel pressure to conform to a false norm.) The MAP also sought to increase harm reduction practices among those who chose to drink.

Reduced consumption among residential students: The main cohort for the MAP project was freshmen residents entering in fall, 2005. This group was surveyed shortly after entering UHM and in spring, 2006, at the end of their freshman year. Those who remained in the residence halls during their sophomore year were surveyed at the end of that second year, in spring, 2007. There was a decrease in binge drinking (defined as having at least five drinks at a sitting within the two week period prior to the surveys) among this group, both across their freshman year and again during their sophomore year, from 29% in fall, 2005, to 26% in spring, 2006, to 16% in spring, 2007. This decline cannot be directly attributed to the Manoa Alcohol Project; many studies indicate that students drink less as they progress through college. However, the binge drinking rate for MAP sophomore respondents was substantially lower than that of the UHM undergraduate population overall (16% versus 29%). Given some national studies that indicate residential students drink more than other students, this lower rate for sophomores in the residence halls is an indication that the project may have been successful with this group. For this cohort the decline in binge drinking and the difference between binge drinking rates for the cohort versus the undergraduate student body were statistically significant.

The second cohort was freshmen residents entering in fall, 2006. They were surveyed after entrance to UHM and at the end of their freshman year, in spring, 2007. Unfortunately, there was no reduction in drinking rate for this group across the freshman year. However, this group was first surveyed after an orientation that included alcohol education and policy awareness, and their initial binge drinking rate (24%) was lower than the initial rate of the first cohort (29%) and lower than the first cohort‘s rate even at the end of their freshman year (26%). It may be that the techniques used by MAP to reduce high risk drinking are only effective with high rates of such drinking; this has seemed to be the case for similar projects in other schools. However, because of low response rates it is difficult to determine whether these differences between cohorts have any real meaning.

Changes in Beliefs and Behaviors: A series of posters were displayed in the residence halls throughout the grant period to educate students about real campus norms regarding alcohol consumption and risk reduction. Survey responses indicate that anywhere from 28% to 68% of the freshmen residents remembered seeing these posters, depending upon the poster topic. Of those who saw the posters, anywhere from 62% to 100% believed the information. Lower rates of belief were expressed in regard to the quantity and frequency of students‘ alcohol consumption; respondents tended to disbelieve that most students do not drink very frequently or heavily. For example, residents thought that just over 2% of "typical" UHM undergraduates did not drink at all in the last 30 days, whereas almost 43% actually did not drink, according to the National College Health Assessment. When freshmen saw posters citing facts so discrepant from their own beliefs, they apparently chose not to believe the facts. Of those who believed the information presented in the various posters, a fair number said they changed their own behavior or advised someone else to change behavior (from 18% to 59%, depending upon the topic).

The highest reports of changing behaviors or advising others were in regard to recognizing alcohol poisoning and knowing what to do if they think someone has overdosed on alcohol.Reducing Harmful Consequences: The MAP project was a harm reduction effort. That is, the major focus was on reducing harm from drinking rather than to "just say no", although the illegal aspect of drinking under age 21 was continually emphasized. Harm reduction has been shown to be a far more effective approach than abstinence for the college population.

Survey results comparing freshmen residents (drinkers only) in fall, 2005 to those same students two years later in spring, 2007, indicate that harmful consequences associated with drinking were reduced in all areas except for drinking and driving. Statistically significant reductions were found for "losing memory" and "passing out", with 50% of drinkers losing memory in fall, 2005, compared to 30% in spring, 2007, and the percent of drinkers passing out going from 34% to 20%.

Driving under the influence is the only area in which increases were found across both cohorts, from college entrance to ending surveys. For the first cohort, driving after drinking any alcohol (within the last 30 days) increased from 8.9% to 13.3%; driving after drinking 5 or more drinks (in the last 30 days) rose from 3.7% to 6.7%. Although these increases were not statistically significant and/or may simply reflect the fact that older students are more likely to have cars, they are a cause for concern.

The surveys also looked at consequences for non-drinkers as well as drinkers, and these consequences tended to decline across the project period. The only statistically significant decrease was in being verbally or physically threatened by someone who had been drinking. In fall, 2005, almost 20% of respondents indicated they had experienced verbal or physical threats from a drinker; in spring, 2007, that figure had dropped to 7%. Understandably, drinkers tended to be more likely than non-drinkers to suffer consequences from other drinkers, although the only statistically significant difference was "riding in a car with someone who had been drinking". Nearly double the proportion of drinkers reported riding with someone who had been drinking, compared to non-drinkers.

Screening and Brief Intervention

A second federal grant, for the period July, 2005 to July, 2008, was awarded to the Health Promotion Program through the U.S. Substance Abuse and Mental Health Service Administration‘s Center for Substance Abuse Treatment. Under this project, alcohol and other drug screening was initiated at the Health Service. Students referred from the Health Service can voluntarily attend the BASICS program (Brief Assessment and Intervention for College Students), consisting of two individual counseling sessions for those at risk of alcohol or other drug misuse and abuse. In addition, students who violate Housing or Student Conduct policies are referred for BASICS counseling. The targeted number of students has been reached for the three year period (354); a six month follow-up survey assesses outcomes of this project. These students generally are in the high risk group, most likely to binge drink or use illegal drugs. Also, the vast majority attended BASICS involuntarily, as part of sanctions for policy violations. Nevertheless, preliminary data indicate that, overall, counseling has had a positive impact. At intake, only 7.1% reported abstaining from all alcohol and illegal drugs for the 30 days prior to being interviewed; at the six month follow-up, 13.6% reporting abstaining, a rate of change of 92%.

Ongoing Projects:

While the above data indicates that progress is being made, reducing alcohol and other drug use on campus is a long-term effort, especially given that many new students enter college each year with already established habits of use. Both primary prevention and intervention with those at risk will continue. A grant from Anheuser Busch is providing funding for continued norms clarification and harm reduction campaigns, and a permanent position has been established to continue alcohol intervention for those at risk. ###